Increased and continuous coronary arterial flow was induced by LV uncoupling condition using combined treatment of a microaxial heart pump and venoarterial extracorporeal membrane oxygenation
Abstract An emerging therapeutic modality, ECPELLA, which combines a transvalvular microaxial left ventricular (LV) assist device, Impella, and venoarterial membrane oxygenation (VA‐ECMO), has been applied for patients with refractory cardiogenic shock. During ECPELLA support, VA‐ECMO increases the...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-10-01
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| Series: | Physiological Reports |
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| Online Access: | https://doi.org/10.14814/phy2.15084 |
| _version_ | 1818738756504518656 |
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| author | Motoko Kametani Masahiro Yamada Yoko Horibata Tomohiro Sakamoto Takashi Unoki |
| author_facet | Motoko Kametani Masahiro Yamada Yoko Horibata Tomohiro Sakamoto Takashi Unoki |
| author_sort | Motoko Kametani |
| collection | DOAJ |
| description | Abstract An emerging therapeutic modality, ECPELLA, which combines a transvalvular microaxial left ventricular (LV) assist device, Impella, and venoarterial membrane oxygenation (VA‐ECMO), has been applied for patients with refractory cardiogenic shock. During ECPELLA support, VA‐ECMO increases the LV load, whereas the Impella reduces the LV load. Studies reported that coronary perfusion is influenced by LV unloading conditions, and the effective degree of LV unloading to increase the coronary perfusion on ECPELLA support remains to be determined. Here, we reported a cardiogenic shock case whose coronary arterial flow was assessed by transesophageal echocardiography during ECPELLA support. The left anterior descending coronary artery (LAD) peak blood flow velocity and the velocity time integral (VTI) were not significantly increased when blood was ejected from the LV (partial LV unloading). When the LV blood ejection was completely bypassed by Impella confirmed by non‐pulsatile aortic pressure with significantly reduced LV pressure with no aortic valve opening (LV uncoupling: no blood ejection from the LV), both peak velocity and VTI of the LAD were markedly increased and the blood flow became continuous throughout the cardiac cycle. Our case suggests that the coronary arterial flow in the injured myocardium is sensitive to degrees of LV unloading on ECPELLA support. |
| first_indexed | 2024-12-18T01:14:00Z |
| format | Article |
| id | doaj.art-bd0365bc291f400dacfb816b62a6bdbe |
| institution | Directory Open Access Journal |
| issn | 2051-817X |
| language | English |
| last_indexed | 2024-12-18T01:14:00Z |
| publishDate | 2021-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Physiological Reports |
| spelling | doaj.art-bd0365bc291f400dacfb816b62a6bdbe2022-12-21T21:26:01ZengWileyPhysiological Reports2051-817X2021-10-01920n/an/a10.14814/phy2.15084Increased and continuous coronary arterial flow was induced by LV uncoupling condition using combined treatment of a microaxial heart pump and venoarterial extracorporeal membrane oxygenationMotoko Kametani0Masahiro Yamada1Yoko Horibata2Tomohiro Sakamoto3Takashi Unoki4Division of Cardiovascular Medicine Saiseikai Kumamoto Hospital Cardiovascular center Kumamoto City Kumamoto JapanDivision of Cardiovascular Medicine Saiseikai Kumamoto Hospital Cardiovascular center Kumamoto City Kumamoto JapanDivision of Cardiovascular Medicine Saiseikai Kumamoto Hospital Cardiovascular center Kumamoto City Kumamoto JapanDivision of Cardiovascular Medicine Saiseikai Kumamoto Hospital Cardiovascular center Kumamoto City Kumamoto JapanDivision of Cardiovascular Medicine Saiseikai Kumamoto Hospital Cardiovascular center Kumamoto City Kumamoto JapanAbstract An emerging therapeutic modality, ECPELLA, which combines a transvalvular microaxial left ventricular (LV) assist device, Impella, and venoarterial membrane oxygenation (VA‐ECMO), has been applied for patients with refractory cardiogenic shock. During ECPELLA support, VA‐ECMO increases the LV load, whereas the Impella reduces the LV load. Studies reported that coronary perfusion is influenced by LV unloading conditions, and the effective degree of LV unloading to increase the coronary perfusion on ECPELLA support remains to be determined. Here, we reported a cardiogenic shock case whose coronary arterial flow was assessed by transesophageal echocardiography during ECPELLA support. The left anterior descending coronary artery (LAD) peak blood flow velocity and the velocity time integral (VTI) were not significantly increased when blood was ejected from the LV (partial LV unloading). When the LV blood ejection was completely bypassed by Impella confirmed by non‐pulsatile aortic pressure with significantly reduced LV pressure with no aortic valve opening (LV uncoupling: no blood ejection from the LV), both peak velocity and VTI of the LAD were markedly increased and the blood flow became continuous throughout the cardiac cycle. Our case suggests that the coronary arterial flow in the injured myocardium is sensitive to degrees of LV unloading on ECPELLA support.https://doi.org/10.14814/phy2.15084coronary arteryECPELLALV uncouplingrefractory cardiogenic shock |
| spellingShingle | Motoko Kametani Masahiro Yamada Yoko Horibata Tomohiro Sakamoto Takashi Unoki Increased and continuous coronary arterial flow was induced by LV uncoupling condition using combined treatment of a microaxial heart pump and venoarterial extracorporeal membrane oxygenation Physiological Reports coronary artery ECPELLA LV uncoupling refractory cardiogenic shock |
| title | Increased and continuous coronary arterial flow was induced by LV uncoupling condition using combined treatment of a microaxial heart pump and venoarterial extracorporeal membrane oxygenation |
| title_full | Increased and continuous coronary arterial flow was induced by LV uncoupling condition using combined treatment of a microaxial heart pump and venoarterial extracorporeal membrane oxygenation |
| title_fullStr | Increased and continuous coronary arterial flow was induced by LV uncoupling condition using combined treatment of a microaxial heart pump and venoarterial extracorporeal membrane oxygenation |
| title_full_unstemmed | Increased and continuous coronary arterial flow was induced by LV uncoupling condition using combined treatment of a microaxial heart pump and venoarterial extracorporeal membrane oxygenation |
| title_short | Increased and continuous coronary arterial flow was induced by LV uncoupling condition using combined treatment of a microaxial heart pump and venoarterial extracorporeal membrane oxygenation |
| title_sort | increased and continuous coronary arterial flow was induced by lv uncoupling condition using combined treatment of a microaxial heart pump and venoarterial extracorporeal membrane oxygenation |
| topic | coronary artery ECPELLA LV uncoupling refractory cardiogenic shock |
| url | https://doi.org/10.14814/phy2.15084 |
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